Music Makes Elders with Dementia “Alive Inside”

When Dan Cohen first started telling people about his Music & Memory project, a nonprofit organization that distributes iPods to nursing homes so residents  can listen to their favorite music, a typical response he got was, “Oh, how nice, Dan, you’re giving the old people some music.”

“And I would say, ‘No, you don’t get it,'” Cohen said recently. Hearing music from one’s past is more than merely “nice,” Cohen said. It can instantly elevate the listener’s mood, calm them when they’re restless, and reanimate long-dormant memories — even if the listener is living with dementia.

As Music & Memory’s founder and executive director, Cohen observes the benefits of music in nursing homes every day. But he wanted to make sure outsiders knew he was doing more than just “giving the old people some music.” “People have to see what I’m seeing,” he said. So Cohen hired filmmaker Michael Rossato-Bennett to trail him for a day.

“He ended up following me for three years,” Cohen said.

Alive Inside

The result is Alive Inside: A Story of Music & Memory, a feature-length documentary that shows the power that familiar music can have on elders living with dementia.

In one scene, a man named Henry is transformed after a nursing home worker affixes iPod headphones to his ears. Previously expressionless and unresponsive, Henry becomes active and wide-eyed and starts swaying to the beat of the music.

And the benefits of the music remain even after the headphones come off. “I’m crazy about music!” he says, before singing “I’ll Be Home for Christmas.” 

In this scene, Henry is “speaking and singing from the heart,” Cohen said. For people living with dementia, music can be a “back door to their selves,” he adds. It “hits them where they’re still accessible.”

Audiences have responded to Henry; a rough cut of his scene from the movie has accrued more than 1.3 million views on YouTube. They’ve also embraced the movie itself, which won the Audience Prize in the U.S. Documentary category at the 2014 Sundance Film Festival.

Evolution of an Idea

Cohen said he got the idea for Music & Memory in 2006, when he heard a radio news report on the increasing dominance of digital music. He approached Jed Levine, the executive vice president of the New York City chapter of the Alzheimer’s Association, with his idea. Levine directed him to Ann Wyatt, a New York City-based culture change expert (and former PHI staff member).

“Right away I thought it was a fabulous idea,” she said. She was struck by its person-centeredness and by its low-investment, high-reward simplicity. “I keep telling him he’s going to get a MacArthur,” she said. Wyatt worked alongside Cohen to develop his idea. (Today she serves on the board of Music & Memory.)

In 2008, with support from the Shelley & Donald Rubin Foundation, Cohen distributed 200 iPods to four nursing homes in the New York area. Results were positive, and Music & Memory was officially formed into a nonprofit in 2010. Since then, Cohen said, the project has expanded to approximately 450 facilities — nursing homes, hospice care, adult day care, and even home care agencies — in 38 states and in 8 different countries.

The Benefits of Music

Long-term care facilities that choose to adopt Music & Memory receive a “continuous flow of both expected and unexpected therapeutic outcomes,” Cohen said. He found that sharing music can alleviate residents’ feelings of isolation and loneliness — a common problem in nursing homes. Elders use music to spark nostalgic conversations about the good old days, or a way to introduce personal stories (“This song reminds me of my husband…”).

Music can also be used to ameliorate difficult interactions between elders and direct-care workers, Cohen said. People living with dementia (or a mental illness such as severe depression, bipolar disorder, or schizophrenia) can demonstrate self-protective behavior during care. But Cohen has found that music has a soothing effect, making elders “significantly” more amenable to necessary care tasks: “Sure, I’ll take a bath, I’ll let you do whatever you need to do — I’m having a good time with my music.”

The Music & Memory website cites dozens of scholarly papers that have been published about the therapeutic effects on music and the ability to reduce agitation and anxiety in people with dementia. But Wyatt points out that often, the simplest benefit can be overlooked by such research: the fact that music brings pleasure to people. “I told Dan: Don’t just measure agitation; make sure the idea of pleasure is out in front, because it’s important,” she said. 

Indeed, Wyatt believes that audiences have responded to Alive Inside primarily because it highlights the profound joy music can bring to elders. “People are so moved by the idea that people with dementia can experience pleasure,” she said. “They just think that’s huge. And it is huge.”

“Everybody Wins”

Cohen concedes that some nursing home staff have initially expressed skepticism about Music & Memory. Administrators worry about costs, training time, and the legality of distributing digital music throughout a facility; while some frontline caregivers have wondered if they would be accused of stealing if an iPod were to go missing. 

But virtually every care facility that becomes involved with Music & Memory embraces the concept with open arms. (Cohen said that only one percent of facilities that have adopted the Music & Memory ended up dropping it.) “As soon as they see the benefits, they’re in,” Cohen said.

“Everybody wins,” Cohen added, not just residents. Family members get to see their loved ones open up emotionally, sometimes for the first time in years, after they listen to familiar music. Visitors to nursing homes end up “staying longer and having a better time,” Cohen said. Direct-care staff also benefit from a less stressful, more fun work environment. “Any time you can give pleasure to a resident, it improves the workplace,” Wyatt said.

But the most important result of Music & Memory, Cohen said, is the profound emotional impact on elders with dementia. “If these benefits were given in a pill, it would be a billion-dollar blockbuster,” he said. “Doctors would be lining up to prescribe it. There is no downside to this.”